Cytoreductive nephrectomy in patients with metastatic non-clear-cell renal cell carcinoma (RCC)

Authors


  • A.A.A. and Y.U. contributed equally to the work
  • P.L.N. and T.K.C. contributed equally to the work

Abstract

Objective

  • To determine whether patients with metastatic non-clear-cell renal cell carcinoma (RCC) benefit from cytoreductive nephrectomy (CN).

Patients and Methods

  • We used the Surveillance, Epidemiology, and End Results (SEER) programme to identify a population-based sample of 4914 patients diagnosed with metastatic RCC between 2000 and 2009.
  • Of the 4914 patients, 591 had non-clear-cell histology.
  • The median follow-up was 20 months.
  • The primary outcome measure was RCC-specific mortality.

Results

  • Approximately 64% of patients underwent CN.
  • Patients with non-clear-cell histology who underwent CN had lower RCC-specific and all-cause mortality than those who did not (P < 0.001 in both cases).
  • After adjustment for age, gender, race, marital status, year of diagnosis, geographical location and histology, the associations between CN and lower RCC-specific mortality (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.48–0.80, P < 0.001) and between CN and all-cause mortality (HR 0.45, 95% CI 0.37–0.55, P < 0.001) remained highly significant.
  • Among patients diagnosed between 2006 and 2009 (targeted therapy era), the results remained unchanged (HR 0.50, 95% CI 0.34–0.72, P < 0.001 and HR 0.43, 95% CI 0.31–0.59, P < 0.001, respectively).
  • An interaction model found lower all-cause mortality for all histologies after CN.

Conclusions

  • Patients from the SEER programme with metastatic non-clear-cell RCC, including those treated in the targeted therapy era, appear to derive a survival benefit from CN, an association which remained significant regardless of histological subtype.
  • This observation suggests that CN should remain standard in patients with advanced RCC who are deemed to be surgical candidates.

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